QR Management of Neonatal Jaundice (Second Edition) PDF
QR Management of Neonatal Jaundice (Second Edition) PDF
QR Management of Neonatal Jaundice (Second Edition) PDF
MANAGEMENT OF
NEONATAL JAUNDICE (Second Edition)
KEY MESSAGES
1. Neonatal jaundice (NNJ) is common in newborn babies. Severe NNJ can lead to acute &
chronic bilirubin encephalopathy.
2. NNJ within 24 hours of life is abnormal and needs urgent attention.
3. Assess all babies for jaundice at every opportunity. Methods include visual assessment,
transcutaneous bilirubinometer (TcB) or total serum bilirubin (TSB)
4. The adequacy of breastfeeding, weight & hydration status of all babies should be assessed
during the first week of life. Refer babies with weight loss ≥7% of birth weight for further
evaluation.
5. Screen all babies for Glucose-6-phosphate dehydrogenase (G6PD) deficiency. Babies with
G6PD deficient should be admitted for the first five days of life.
6. Start phototherapy when TSB reaches the phototherapy threshold. The threshold is lower
in preterm & low birth weight babies.
7. Consider exchange transfusion (ET) when TSB reaches the ET threshold. This should
follow a standardised protocol & be supervised by experienced personnel.
8. Babies discharged <48 hours after birth should be seen by a healthcare provider in an
ambulatory setting or at home within 24 hours of discharge.
9. Continue breastfeeding in babies with jaundice. Provide adequate lactation support to all
mothers, particularly those with preterm babies.
10. Babies with acute bilirubin encephalopathy (ABE) should have long-term follow-up to
monitor for neurodevelopmental sequelae. Auditory Brainstem Response testing should be
done within the first three months of life.
This Quick Reference (QR) provides key messages & a summary of the main
recommendations in the Clinical Practice Guidelines (CPG) Management of Neonatal
Jaundice (Second Edition).
Details of the evidence supporting these recommendations can be found in the above CPG,
available on the following websites:
Ministry of Health Malaysia: http://www.moh.gov.my
Academy of Medicine Malaysia: http://www.acadmed.org.my
Malaysian Paediatric Association: http://www.mpaweb.org.my
Perinatal Society of Malaysia: http://www.perinatal-malaysia.org
CLINICAL PRACTICE GUIDELINES SECRETARIAT
Health Technology Assessment Section
Medical Development Division, Ministry of Health Malaysia
4th Floor, Block E1, Parcel E, 62590 Putrajaya
Tel: 603-8883 1246 E-mail: htamalaysia@moh.gov.my
• This QR & its CPG do not address prolonged jaundice.
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NEONATAL JAUNDICE (SECOND EDITION)
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NEONATAL JAUNDICE (SECOND EDITION)
a. Start intensive phototherapy at a TSB level of 3 mg/dL (51 µmol/L) above the
level for conventional phototherapy or when TSB increasing at >0.5 mg/dL (8.5
µmol/L) per hour
b. Risk factors are isoimmune haemolytic disease, G6PD deficiency, asphyxia &
sepsis.
*Jaundice appearing within 24 hours of life is abnormal & needs further evaluation.
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NEONATAL JAUNDICE (SECOND EDITION)
*Jaundice appearing within 24 hours of life is abnormal & needs further evaluation.
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NEONATAL JAUNDICE (SECOND EDITION)
Predischarge screening
• Predischarge screening should be used to prevent severe NNJ in late preterm &
term babies.
Clinical risk factor assessment or/& predischarge bilirubin levels (TcB or TSB)
Nomogram for designation of risk at ≥36 weeks’ gestational age with birth
weight ≥2000 g or ≥35 weeks’ gestational age with birth weight ≥2500 g
5
QUICK
QUICKREFERENCE
REFERENCEFOR
FORHEALTHCARE
HEALTHCAREPROVIDERS
PROVIDERS MANAGEMENT
MANAGEMENTOF
OFNEONATAL
NEONATALJAUNDICE
JAUNDICE(SECOND
(SECONDEDITION)
EDITION)
1. BabiesHome
with visits by healthcare
gestational age 35 - providers duringclinical
37 weeks WITH postnatal
riskperiod
factors in (A)
• &Home visits should
predischarge be doneinfor
TcB/TSB theallfollowing
newbornsrisk
on day 1, 2, 3, 4, 6, 8, 10 & 20.
zones:
• If jaundice is detected, TSB should be measured & managed accordingly.
Predischarge Action Interval to
TcB /TSB Risk repeat TSB
Laboratory investigations to be considered for severe or early-onset NNJ
Zone
•HighG6PD • Check
Risk test (if not TcB/TSB against
screened) • Fullphototherapy
blood countguidelines
± peripheral4blood
- 8 hours
picture
• Start phototherapy as needed
• Mother’s & baby’s blood group • Reticulocyte count
•HighDirect Coombs• test
Check TcB/TSB against phototherapy
• Septic workupguidelines
(if infection is4suspected)
- 24 hours
Intermediate Risk • Start phototherapy as needed
Low Intermediate If discharging in <72 hours, follow-up within 2 days
Within 2 days at
Risk Indications for referral to hospital follow-up
•LowOnset
Risk of jaundice within 24inhours
If discharging of lifefollow-up within 2 days
<72 hours, If jaundiced at
• Rapidly rising TSB of greater than 6 mg/dL/day (103 µmol/L/day) follow-up
• Clinical jaundice below umbilicus (if till the soles of the feet - urgent referral for
2. Babies with
possibility of gestational
ET) age 35 - 37 weeks with NO clinical risk factors in
• (A)
G6PDORdeficiency
with gestational age ≥38 hospitalised)
(if not previously weeks WITH clinical risk factors in (A) &
• predischarge TcB/TSB in
Clinical symptoms/signs the following
suggestive risk zones:
of sepsis
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NEONATAL JAUNDICE (SECOND EDITION)
NNJ
G6PD Deficiency
Assess Admit
risk factors
Yes No
Jaundice
Yes
Need
admission Need treatment Phototherapy ± ET
No
Jaundice resolved
Monitor as Yes
scheduled*
No
Yes Discharge
and follow-up
*If jaundice persists beyond 14 days in term babies & 21 days in preterm babies, further
evaluation for prolonged jaundice is needed.